Breast Cancer Surgery has undergone a lot of change in the last few years. Earlier, mastectomy (full breast removal) was the norm for breast cancer management, but nowadays if the cancer is detected early, Breast Conservation Surgery (BCS) can be carried out.
In breast conservation surgery (BCS), only the cancerous lump and some portion of normal breast tissue around it is removed, preserving the rest of the breast, thereby leading to a better cosmetic outcome for the patient. BCS is also psychological and physically better for a patient suffering from breast cancer. The overall survival, whether the patient undergoes BCS or mastectomy for breast cancer treatment, remains the same.
Breast conservation surgery should be carried out by a trained breast cancer surgeon (breast onco-surgeon). A frozen section analysis should be done at the time of surgery to confirm that the tumor has been adequately removed.
Information provided by:
Dr. Rohan Khandelwal
W Pratiksha Hospital
Autologous fat grafting (fat transfer) is a technique in which fat is harvested from the patient using liposuction and after centrifuging, this fat is introduced in the sub-dermal and retro-glandular portions of the breast to augment the breast.
This technique has also been used to fill up post lumpectomy defects following breast conservation surgery for breast cancer.
Advantages of the procedure:
- No foreign material or implant is used
- Double benefit of liposuction from the donor site
- Relatively cheap as compared to an implant based reconstruction
- Day care procedure
- Natural feel & contour of the breast
- Only 70-80% of fat cells transferred by this technique survive, therefore, there is some amount of volume reduction after the procedure. In some cases, multiple sittings might be required to achieve the desired results.
- As these fat cells die, they can sometimes give rise to calcifications, which can be confused for malignant/benign lesions on a mammogram
- Haematomas & bruising in the immediate post-op period
The following video demonstrates a case of primary breast augmentation using fat grafting:
With the increase in opportunistic screening of Breast Cancer in India, more and more impalpable breast lesions are being detected. Wire guided localisation is one method to surgically deal with these lesions.
This video highlights the operative steps of wire guided localization and also the use of a specimen mammogram.
Dr. Rohan Khandelwal
Consultant, Breast Onco-surgeon
W Pratiksha Hospital
Image highlighting the boundaries of axillary clearance
Breast conserving surgery (BCS) is fast becoming popular but one should be aware of the the contraindications of this procedure in order to avoid high recurrence rates & complications.
Breast conserving surgery in simple words is lumptectomy (removal of the tumor with a normal rim of tissue). All patients following BCS require radiotherapy. Some of the contraindications of this procedure are related to the surgical aspect whereas others are contraindications for radiotherapy.
- Pregnancy – is a contraindication for radiotherapy, as it can lead to teratogenic effects.
- Two or more primary tumors in separate quadrants (multicentric tumors). Patients with multifocal tumors (two or more primaries in the same quadrant) can undergo BCS. [Fig 1]
- Diffuse malignant-appearing calcifications on mammogram
- History of prior radiation to the breast area
- Persistent positive margins
- Inflammatory breast cancer
- History of collagen vascular disease – leads to increased radiotherapy associated complications
- Breast size to tumor size ratio [Fig 2] – Instead of the absolute size of the tumor, tumor/ breast ratio is a better indicator of whether the patient is eligible for BCS or not. Fig 2 – highlights two patients, both with identical tumor sizes but one patient has a large breast (leading to a small tumor/ breast ratio) whereas the other patient has a small breast (leading to a large tumor/ breast ratio). BCS is avoided in patients with large tumor to breast ratio as it leads to poor cosmetic outcome.
Following are NOT contraindications to BCS:
- Family history of breast cancer
- Positive lymph nodes
- Bilateral breast cancer
- Lobular histology
- Central quadrant tumor